A Lifelong Journey

treatment

Sitting in my therapist office, reflecting on his traditional opening question (“So, what are we going to talk about today?”), I found myself giving that answer. Because that is what I had reflected on recently. That is what my mind had been on during the drive over. That was what I had come to believe needed to be a significant goal for me going forward.

As the one year anniversary of my hospitalization (and subsequent release) approaches, I have been faced with the reality of having survived the breakdown. Since the first week of September last year, I have avoided any episodes along the lines or magnitude of that horrific week. It has not been easy. At times, harder than hell. But I have managed. I have given intense focus to the big three (Sleep, Therapy, Medications), and have tried to consider most other things the minors to those majors. I have attempted to reward myself more, punish myself less, recognize small accomplishments, and let other takers be my worst enemy rather than fulfilling that role myself. But that all has left me with the question, “Now what?”

That is what has been stuck in my craw (because in Kentucky, we use phrases like that). Now what? Or, put another way. Possibly a more negative way. The question might go like this: “Is this really as good as it gets?” Is this the way I need to anticipate living the rest of my life? Is this the best I can do? This combination of drugs providing this baseline of emotions just this side of depression. This cycle of sleep merging nights and naps and zombie like periods of awake. This week after week battle to get out of bed and knock another seven days off the calendar.Having survived the big scare, it seems logical that my attention might shift to the year after. And dare I venture to let my mind explore the possibility not merely of having survived, but now attempting to find a way to thrive.

Having survived the big scare, it seems logical that my attention might shift to the year after. And dare I venture to let my mind explore the possibility not merely of having survived, but now attempting to find a way to thrive.

I have set some goals as to what this might look like. First, I have more than five months left in the insurance year with my out-of-pocket limit reached. Therefore, I will be meeting with my medications coordinator next Tuesday and asking her if we might experiment a bit. Venture away from the only cocktail I have utilized since leaving the hospital in an effort to find something that leaves me a little less comatose. A little less down. A little less fat!

Second, the employment situation simply does not seem sustainable for the long haul of my life. The doctors in Chicago didn’t think it was. The team at home seems to question whether it is. My own physical and mental stability seems to doubt it. Granted, for us bipolar, few employment situations seem sustainable for the long haul, but I do think there are three standards I can improve on: a) a later wake-up time than 3 a.m., b) weekends off, and c) the ability to accrue some paid time off (i.e. vacation). Seems reasonable, right? In four more weeks, I will have two children living out-of-state, and I need the opportunity to visit them. This job simply does not afford that. Financially, or time wise.

Finally, and this one is so hard, I have to lose some weight. I’m up 20 lbs since leaving the hospital…as the staff there suggested it would be easy to be. I’m up 30 lbs since losing almost 50 roughly three years ago. It takes a toll on me physically, emotionally, and motivationally. So as much as I disdain working out and dieting…I have to lose weight if I want to improve my quality of life.

For much of this, I have less idea of how to make it happen than I do the need for it to happen. But this is the next year before me. A year of quality of life. A year of improved quality of life. As long as I’m going to stick around, seems like I might as well enjoy doing so.

Last week I did not do well. Had a few really rough days. Less than 5 out of 10s on the “How the hell are you doing?” scale.

As is often the case, it was a little thing that set it off. But somewhat unusually, it wasn’t the little thing that plunged me down or kept me there. In fact, I would ascribe…oh, let’s say 5% to the event and 95% to my feelings that followed the event.

Let me see if I can find a way to describe this. Much like every other human being in the world, I experienced a mildly hurtful moment. I simply wasn’t quite thought of as much as I would have like to have been. A request came, I didn’t think it was filtered through my needs, and that frustrated me. It really was no big deal. Not a major slip up by a loved one. It just happened.

But what followed was the reality of how much my neediness requires such requests to be filtered, or even rejected. The request would have potentially impacted my sleep schedule. It might have thrown off my “night before work” rhythm. It could impact my routines that I tend to hold quite dear.

Now, I get that not everyone reading this is going to get this. However, there are those of you out there who are totally going to understand the power of those three words: schedule, rhythm, and routine. You not only understand them, you see them as lifelines. You see them as foundational to keeping your shit together. Like me, you know that the break in any one of or more of those three can be the snowflake that starts the avalanche or the pebble that initiates the rock slide. Both of which cause great messes, significant damage, and possibly loss of life.

Yes, that sounds very dramatic. And yes, if you knew the request I was presented with, you would think it is way overly dramatic. But here is the thing…we never know. We never know when that little thing that we pass off as a little thing because we don’t think it will be a big thing ends up being. (Yeah, you might have to read that one again.) I could have rolled with the request, and everything may have gone fine. Or I could have rolled with the request, and a few days later been in real trouble.

Which gets me back to the 95%. The part that plunged me into a fairly dark hole for a couple of days. It was the reality once again that I am Bipolar. The reality once again that I have a mental illness. The reality, right in the middle of life chugging along fairly reasonably, that such small things can become big things and big things can become life and death things.

It was a reality that cranked up ideation and thoughts. Yeah…that kind of ideation and thoughts. A reality that caused an overwhelming pain at the reality of never getting better. A reality that we aren’t just waiting for my insurance company to approve the treatment that is going to “fix” me.

No, the reality is that more times than not these simple requests will have to be met with “No. I can’t.” answers. And the fact that someone actually asking will probably hurt less and less, while the reality that I had to say “no” will probably just keep hurting more and more.

It could not have been said more accurately. Yet it was still a bit of a surprise coming from her professional mouth.

We were in our discharge meeting preparing to review financial obligations. My wife, myself, and the social worker. She had walked in the door, greeted us, and opened the meeting with, “Okay, so, your insurance is ass.”

As sole proprietors of a business, and myself the sole employee, we obtained our insurance through the Affordable Care Act (which I remain a fan of). It had a $5,000 deductible, a $6,875 out-of-pocket maximum, and a drug formulary deductible on top of all that. We are talking ‘hasn’t been wiped in a month baby’s ass’ bad.

Here is the thing, and I don’t claim to know the solution, but it doesn’t seem like the best way to send someone off from their recovery from a complete mental health breakdown is to hand them a $7,000 bill that they have no idea how they could ever pay. It is kind of like handing out those little shot bottles of liquor as parting gifts at AA meetings. However, that is what we were facing. Our portion would be $6,875 plus whatever meds I needed filled to continue the drugs I had received in treatment. In practical terms for us, just under 4 months of my take home pay. I might have to sell use of my ass on street corners back home to pay it.

The social worker was sweet and did all she could to help. She advised us of grant assistance that was available and how to apply (still waiting for final word on that after 5 months). She gave us vouchers for meds at the in-hospital Walgreen’s that ended up valued at hundreds of dollars and set me up for 30 days. She did all that she could, including lightening the moment with that opening we will never forget.

We will never forget the details of the bill either. Just over $32,000 for 8 days. Including $125 for each 45 minute recreational therapy session. I enjoyed them. But there were eight of us in supervised coloring and board games. Doesn’t one grand for a small room and a supervisor playing Scategories with us seem a bit excessive?

The most shocking charge was the psychological profile completed of myself. It included 15 minutes of assesment instruction, 90 minutes of direct assessment, an hour reviewing the results with me (fairly insightful), and whatever time was spent by the psychologist reviewing the assesments. Final tab…Eight Large. As in, $8,000. And that didn’t even earn us a copy of the results. We had to request those upon returning home.

Yep, our insurance was…is ass. Unfortunately, only one thing comes out of there.

Like this:

I tend to move through emotional states and stages rather rapidly. Jovial one minute. Angry as all get up the next. Cruising through my day before lunch. In deep depression after. More so off medication than on (duh). But I have yet to say anything unusual for an individual in the throws of Bipolar II.

While Friday had seen me quickly transition from denial to anger (as previously discussed as part of the Five Stages of Grief in my Friday, August 26th, Early Evening post) today would provide another opportunity to knock out a few more stages. Though I didn’t know that at the time.

Having survived the rather ‘less structured’ and thinner staffed weekend of a psychiatric ward, I awoke Monday morning ready to get on with life. I sat on my bed, grabbed a pencil and began drafting a plan for escaping the walls of this institution and returning to my life as I knew it prior to my little meltdown (yeah…I know, still some echoes of the “denial” phase hanging around). Phrased another way, I began to map out my “bargaining”(Stage Three) plan.

The plan was to serve a couple of purposes. First, to show that I was cognizant and aware of the realities of life. Family. Friends. Work. Looking back at the page of notes, it is almost comical to see that there is not a mention of aftercare. Almost.

Second, the way I figured it, anyone able to so clearly delineate his responsibilities, obligations and commitments couldn’t possibly be crazy (there’s that ol‘ “denial” again).

Third, I knew whatever was going on during my stay wasn’t free. In fact, the tab had to be running hard and fast. With an insurance policy carrying a $5,000 deductible and a few more grand in out-of-pocket maximum charges, I needed to get moving (little did I know those numbers had been blown by some time ago!).

Fourth, and most importantly to my well rested and to be quite honest somewhat bored mind, it would get the ball rolling. While this was my first go around with mental health inpatient care, it was not my first go around with a hospital. A little over 18 months prior I had suffered a heart attack and spent a few days catching my breath at a half-dozen grand a day. Therefore, I was well aware that getting checked out was typically about as slow a process as getting admitted. If I wanted out before Thanksgiving (or say…Wednesday), I need to get things moving to help encourage others to do the same.

Anyone seeing why during my stay, evaluations and subsequent therapy it will be highlighted that I might have control issues?

I went to breakfast and came back to see what type of schedule had been written on my white board for my day of treatment. It was significantly different than the weekend. Namely, it was jammed with group sessions, treatment, teaching, and structure. Oh my.

I grabbed the handy dandy patient folder that I had been provided and began to notice there was a sheet for Monday. For Tuesday. Wednesday. Thursday. Even Friday. There was a form explaining the “week long” format for recovery and treatment structure.

What already felt to me like Day 5, they were seeing as Day 1. What felt to me like a good time to start packing, they were seeing as time to get to work.

What felt to me like the opportunity for Stage Three Bargaining…was giving way to Stage Four Depression.